redmomof4
06-25-2011, 12:12 PM
Please forgive me if I ramble on. I am a newer CRNA who left the big university setting to go to a rural CAH with 2 CRNAs employeed by the hospital. In my program in school, we had a few rural rotations and I feel like I learned a small amount regarding billing to know that when I got to my new job, we were missing out on a large amount of revenue. I was told on my first day that we cannot list modifiers on our charge sheet, there was no place for the surgical procedure on the billing sheet, and much more.
We had a meeting with our billing dept on Thursday. I left the meeting feeling like I had no say, I was told, "no we cannot do that... no we don't even send codes in for LESIs or Brachial Plexus blocks because Medicare kicks it out and denies the whole claim" WHAT?! Excuse me? Why would people do these and follow stringent documentation guidelines to obtain reimbursement if it is automatically denied? I was told that I cannot bill for medical/surgical codes, because I am anesthesia, a CRNA, not a physician. She told me that anesthesia can only bill for 5 digit CPT codes starting in 0 or 00 with the defense being that our hospital is a rare situation being that we are a provider based clinic, Critical Access Hospital that bills under the optional Method II Medicare billing. I do not think we take advantage of the rural passthrough funding any more, although they used to. Anyone have experience with this?
I feel like I've been spending an astronimical amount of time trying to understand the medicare billing options and how that could affect our anesthesia billing. I'm overwhelmed and am only more convinced that she has done our small hospital a great disservice.
I find out today our "head billing person" doesn't even know what an Opt-Out state is and doesn't consider me an independent provider. ??? There isn't an anesthesiologist here. I am very frustrated by this situtation, but want to approach my CEO with an appropriate plan to have an analysis of our current and previous billing procedures by an outside company (and possibly turf out our anesthesia billing in the future). Any suggestions where to start with this? I understand he has been approached before and responded with, "why would we do that, we have billing people." I think now is an excellent time to revisit this, especially when he finds out we weren't even attempting to capture charges for procedures we were doing.
Thanks in advance for any advice.
Shawna
We had a meeting with our billing dept on Thursday. I left the meeting feeling like I had no say, I was told, "no we cannot do that... no we don't even send codes in for LESIs or Brachial Plexus blocks because Medicare kicks it out and denies the whole claim" WHAT?! Excuse me? Why would people do these and follow stringent documentation guidelines to obtain reimbursement if it is automatically denied? I was told that I cannot bill for medical/surgical codes, because I am anesthesia, a CRNA, not a physician. She told me that anesthesia can only bill for 5 digit CPT codes starting in 0 or 00 with the defense being that our hospital is a rare situation being that we are a provider based clinic, Critical Access Hospital that bills under the optional Method II Medicare billing. I do not think we take advantage of the rural passthrough funding any more, although they used to. Anyone have experience with this?
I feel like I've been spending an astronimical amount of time trying to understand the medicare billing options and how that could affect our anesthesia billing. I'm overwhelmed and am only more convinced that she has done our small hospital a great disservice.
I find out today our "head billing person" doesn't even know what an Opt-Out state is and doesn't consider me an independent provider. ??? There isn't an anesthesiologist here. I am very frustrated by this situtation, but want to approach my CEO with an appropriate plan to have an analysis of our current and previous billing procedures by an outside company (and possibly turf out our anesthesia billing in the future). Any suggestions where to start with this? I understand he has been approached before and responded with, "why would we do that, we have billing people." I think now is an excellent time to revisit this, especially when he finds out we weren't even attempting to capture charges for procedures we were doing.
Thanks in advance for any advice.
Shawna